Protecting Intimate Relationships as the Dementia Progresses

Transcription

1 Teepa Snow, Positive Approach, LLC to be reused only with permission. Handouts are intended for personal use only. Any copyrighted materials or DVD content from Positive Approach, LLC (Teepa Snow) may be used for personal educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and Positive Approach, LLC Protecting Intimate Relationships as the Dementia Progresses 1

2 Define Intimacy Physical intimacy Intellectual intimacy Emotional intimacy Social intimacy Spiritual intimacy List Three Common Intimate Acts in Each Category Physical intimacy Intellectual intimacy Emotional intimacy Social intimacy Spiritual intimacy Identify Intimates with relationship words: Physical intimates Intellectual intimates Emotional intimates Social intimates Spiritual intimates 2

3 We want to be intimate because we LIKE We want to be intimate because we LIKE How Many People are Involved? Number of people you are: Physically intimate with? Intellectually intimate with? Emotionally intimate with? Socially intimate with? Spiritually intimate with? 3

4 What Do You Do With For - To the Other? Physically intimate? Intellectually intimate? Emotionally intimate? Socially intimate? Spiritually intimate? What is IMPLICIT with true intimacy? Mutual desire for the relationship Shared responsibility Individual active participation Respect for the other Held apart from others Bonded unwritten contract Patterns Typically Emerge Physical intimacy 1 many Intellectual intimacy 1 many Emotional intimacy 1 many Social intimacy 1 many Spiritual intimacy 1 many 4

5 What Happens When There is ONLY One for ALL? Sense completeness when with Desire to be with Desire to get away from others Satisfaction in the presence of the ot No other relationships No desire for other relationships No time for other No need for other Missing when away What Happens When There are MANY for ONE? Flexibility in each day and night Many ways to achieve satisfaction Variability in where and when and how intimacy is achieved each day Time away to meet other needs and preferences Time to be alone and then with Opportunities for other activities and relationships Joy when with others without guilt So the question is Do YOU still like me? 5

6 AND Do I still LIKE you? with DEMENTIA - What Can Happen When There is ONE for All? Sense of need Sense of fear Sense of isolation when not with Sense of responsibility Missing you Sense of too much Sense of too little Sense of isolation even when with Sense of responsibility Missing you with DEMENTIA - What Can Happen When There is Many for ONE? Sense of loss Sense of need Sense of fear Sense of isolation Sense of empty spaces and times Missing the others Sense of too much Sense of too little Sense of isolation At a loss how to? Missing you Missing me-free time 6

7 How will we get our LIKES met? What will we have to change? What can we keep for now? Who wants the change and who does not? Who might help each of us? Where can we go for help? How will we each know when each of us needs help? List Three Common Intimate Acts in Each Category with Early State Dementia Physical intimacy Intellectual intimacy Emotional intimacy Social intimacy Spiritual intimacy List Three Common Intimate Acts in Each Category with Mid-State Dementia Physical intimacy Intellectual intimacy Emotional intimacy Social intimacy Spiritual intimacy 7

8 List Three Common Intimate Acts in Each Category with Late State Dementia Physical intimacy Intellectual intimacy Emotional intimacy Social intimacy Spiritual intimacy What Changes? The number of tasks The types of tasks The responsibility for the timing of the tasks The responsibility for judging quality of task performance The mutual desire for the intimacy in various activities Sense of mutuality What might others do With For - To the Other with Dementia? Physically intimate activities? Intellectually intimate activities? Emotionally intimate activities? Socially intimate activities? Spiritually intimate activities? 8

9 How do each of you feel about that? How you say what you say matters! How you do what you do matters! Learn to do WITH not TO or FOR! Role Changes Who changes? What changes? When does it change? How does it change? Why does it change? 9

10 Why Do Roles Change? Cognitive impairment affects everything about the person you love & care about Abilities are changing with or without awareness Awareness varies Your lives have been connected in some ways those connections are changing Why? Memory changes Communication changes Impulse control changes Judgment changes Emotional control changes Reasoning changes Skill changes PET and Aging PET Scan of 20-Year-Old Brain PET Scan of 80-Year-Old Brain ADEAR,

11 Positron Emission Tomography (PET) Alzheimer s Disease Progression vs. Normal Brains Normal Early Alzheimer s Late Alzheimer s Child G. Small, UCLA School of Medicine. Possible other Cognitive Impairments S/P Tramatic Head Injury s/p CVA Dementia Side-effects from other Medical Conditions or Medications or Treatments Acute Delirium Others. Alzheimer s New info lost Recent memory worse Problems finding words Mis-speaks More impulsive or indecisive Gets lost Notice changes over 6 months 1 year 11

12 Vascular Dementia Sudden changes Picture varies by person Can have bounce back & bad days Judgment and behavior not the same Spotty losses Emotional & energy shifts Lewy Body Dementia Movement problems - Falls Visual Hallucinations Fine motor problems hands & swallowing Episodes of rigidity & syncopy Nightmares Fluctuations in abilities Drug responses can be extreme & strange Fronto-Temporal Dementias Many types Frontal impulse and behavior control loss Says unexpected, rude, mean, odd things to others Dis-inhibited food, drink, sex, emotions, actions Temporal language loss Can t speak or get words out Can t understand what is said, sound fluent nonsense words 12

13 Who changes? Everyone involved will have some changes Male-female patterns over life Parent-child patterns over life Sibling patterns Friendship relationships Authority relationships Care relationships What Changes & What Doesn t? WHAT CHANGES. Who does what How things get done Habits More changes are coming There are losses in roles There are losses in activities These may be accepted or NOT Understanding & acceptance of new info and situations WHAT DOESN T Old habits & patterns Many old values Desire to be respected Many beliefs about how things should be Many beliefs about how people should behave Loss of Roles Person with Cognitive Impairment MEN Father Husband Driver Financial manager Bread winner Boss decision maker Leader (work, church ) Team member or Club member Volunteer Sportsman Partner Supervisor WOMEN Mother Wife Home maker Worker Cook Visitor Shopper Advice giver Group leader or member Caregiver Church member Laundress 13

14 Common Loss of Activities Physically complicated activities Physically demanding activities Cognitively challenging activities Social activities Spiritual activities Leisure activities Family activities Most valued activities Most fun and enjoyable activities When Does It Change? Earlier than you think Earlier than it needs to Before you notice it is happening After an episode a crisis point When someone gets hurt or is at risk When you can t take it any more When Authorities tell you it MUST Too late How Does It Change? Varies with each situation Depends on lifetime patterns Depends on specific symptoms being noted Can be TOO MUCH TOO SOON Can be too little too late Can be just right! 14

15 How Does It Change- BETTER? Get expert help Get support for the change Decide who is most acceptable to do what Figure out how the person can still have a role that is acceptable to them Set it up as a Let s give this a try Provide alternatives that are OK How to Communicate How to say it What to say How to respond to So WHAT should we do??? Remember who has the healthy brain Use your healthy brain Be willing to change your - approach - words routine - actions habits - plans rules - beliefs Arrangements Environment 15

16 What shouldn t we do??? Argue Make up stuff that is NOT true Ignore problem behaviors Try a possible solution only once Give up Let them do whatever they want to Force them to do it How to Help Use empathy Pick times to address at best time for the person Offer redirection Later on offer distraction Pre-set offer before the ask Let others be the BAD GUY How to Decide What Must Be Taken Over How to keep the role but take over key activities that are critical safety wise Driving Cooking Finances Shopping Advance PLANNING is the KEY Durable HC POA Durable $ POA Talking about it BEFORE it is happening what if Consulting experts & asking for help Provide options Reduce cues Do other things 16

17 How to Figure Out if IT is WORKING. You are feeling better There are fewer fights There is less distress You have money The problem behavior is reduced or stopped The new relationship is working for you and the other people you love How to Introduce the Changes Act like it has always been this way nothing new See if we can try something new said we should (respected authority figure or family member) Just 1-2 at a time (pick your top priorities Develop alternatives that are OK Try, try again How to Live with the Changes GET SUPPORT for you Cry every now and then for what you have lost Find joy in the new relationship you are building Get help, if there is NO JOY Take time to remember Take time for learning and changing 17

18 How to Make It Stick Practice Reinforcement Belief in the value of doing it Eliminate old cues and props Get help from others Start early Think about the alternative How to FEEL OK Get spiritual support Get intellectual support Get physical support Get social support Get expert help, if needed to do tasks Take breaks Pat yourself on the back Think of the alternative Take Care of YOU!!! Stress Tamers 18

19 10 Minute Stress Tamers Sit quietly in calm surroundings with soft lights and pleasant scents. Aromatherapy lavender, citrus, vanilla, cinnamon, peppermint, fresh cut grass. Breathe deeply rest your mind & oxygenate Soak - in a warm bath, or just your hands or feet Read - Spiritual readings, poetry, inspirational readings, or one chapter of what you like Laugh and smile - Watch classic comedians, Candid Camera, America s Funniest Home Videos, look at kid or animal photos Stretch front to back, side to side, & across Garden work with plants 10 Minute Stress Tamers Beanbag heat therapy. Fill a sock with dry beans and sew or tie closed. Heat bag and beans in a microwave for 30 seconds at a time. Place on tight muscles and massage gently; relax for ten minutes. Remember the good times - Record oral memories - scrapbooks, photo journals, keepsake memory picture frames. Just jot! Do a little on a favorite hobby. Have a cup of decaffeinated tea or coffee Play a brain game crosswords, jigsaws, jeopardy, jumbles, sudoku Look through the hymnal and find a favorite hum it all the way through 10 Minute Stress Tamers Books on Tape - Rest your eyes and read Soothing sounds Music you love Music especially for stress relief Recorded sounds of nature Listen to coached relaxation recordings Pamper Yourself think of what you LOVE and give yourself permission to do it for 10 minutes Neck rubs or back rubs use the just right pressure Hand Massages with lotion or without its up to you 19

20 10 Minute Stress Tamers Take a walk. Sit in the sun. Rock on the porch. Pray or read a passage from scripture Journal - Take the opportunity to tell it like it is. Cuddle and stroke a pet. Have that cup of coffee or tea with a special friend who listens well. Pay attention to your personality. If you rejuvenate being alone, then seek solitude. If you rejuvenate by being with others, seek company. 20